Low-level laser therapy (photobiomodulation) versus hyperbaric oxygen therapy on healing of chronic diabetic foot ulcers: a controlled randomized trial

Abstract

Background and purpose

Diabetic foot ulcers (DFU) and concurrent infections are the most frequent complications in patients with diabetes mellitus. Both low-level laser therapy (LLLT), photobiomodulation (PBM), and hyperbaric oxygen therapy (HBOT) promote the healing of wounds. The purpose of this study was to compare the effectiveness of LLLT versus HBOT on the healing of chronic DFU. Patients and methods: Seventy-five patients with chronic diabetic ulcers aged ranging from 40–65 years were recruited and assigned randomly into three groups. HBOT group received 100% pure oxygen 2.5 ATA delivered for 60 min per session for 30 sessions (5 sessions per week for 6 successive weeks). LLLT group received GaAlAs diode laser producing a total power output of 1440 mW with following wavelengths: 5 × 850 nm (200 mW), 12 × 670 nm (10 mW),8 × 880 nm (25 mW), and 8 × 950 nm (15 mW); the energy density (fluency) was adjusted for 4 J/cm² with a pulse frequency of 10 kHz. Each session lasted 8 min every two days. The control group received conventional wound care only (wound cleansing twice daily using saline or similar dressing). Both LLLT and HBOT groups received conventional wound care in addition to their program. Measurements for ulcer surface area (USA; transparency method) and ulcer volume (volumetric method) were performed before starting the study and in the second, fourth, and sixth-weeks post-treatment. Results: Within group comparisons demonstrated a statistically significant decrease in USA and ulcer volume in both HBOT and LLLT groups (p-value = 0.0001 in all measurements). The multiple comparisons between groups for USA, there was insignificant difference between HBOT and LLLT groups after 2-, 4-, and 6-weeks (p-value = 0.48, 0.813, and 0.629, respectively), while for ulcer volume, there was a statistically significant difference in favor of the LLLT group only after 2- and 4-weeks (p = 0.037 and 0.042, respectively) while an insignificant difference after 6-weeks (p-value = 0.911). Conclusion: Both LLLT and HBOT accelerate healing in chronic DFU, but the LLLT is more favorable in decreasing ulcer volume after during the first 4-weeks.

Keywords:

• Hyperbaric oxygen therapy
• GaAlAs diode laser
• diabetic chronic ulcers

Disclosure statement

The authors declared that no conflict of interest related to this study.

Funding

Self-funding, the authors declared no financial support received from any organization to accomplish this research.

Additional information

Notes on contributors

Amir N. Wadee

Ass. Prof. Dr. Amir N. Wadee is an assistant Professor of Physical Therapy in Department of Physical Therapy for Basic Sciences, Cairo University, Egypt. Ph.D. Cairo University 2009: “Influence of Low Level Laser Therapy on Delayed Onset Muscle Soreness in Normal Subjects”. M.Sc. Cairo University 2003: “Influence of Low Intensity Laser Pulse Frequencies on Blood Flow in Normal Subjects”. Engagement in teaching activities of practical courses of Physical Therapy from 1998-2008. Engagement in teaching activities of theoretical courses of Physical Therapy from 2008 till now. Had attended many international conferences, and the last was “The Second Scientific Conference of Physical Therapy - No More Disability with Physical Therapy & Rehabilitation” from 11th-12th Dec. 2020. Had published many international publications, and the last was “Ahmed M. Elshinnawy, Karim A. Fathy, Amir N. Wadee, and Islam H. Fayed. Influence of Cardiorespiratory Fitness on Walking Performance in Chronic Hemiplegic Patients with Myocardial Infarction. IJPR; 10: (8) 119-127. 2021.”

Siham M. Fahmy

Ass. Prof. Dr. Amir N. Wadee is an assistant Professor of Physical Therapy in Department of Physical Therapy for Basic Sciences, Cairo University, Egypt. Ph.D. Cairo University 2009: “Influence of Low Level Laser Therapy on Delayed Onset Muscle Soreness in Normal Subjects”. M.Sc. Cairo University 2003: “Influence of Low Intensity Laser Pulse Frequencies on Blood Flow in Normal Subjects”. Engagement in teaching activities of practical courses of Physical Therapy from 1998-2008. Engagement in teaching activities of theoretical courses of Physical Therapy from 2008 till now. Had attended many international conferences, and the last was “The Second Scientific Conference of Physical Therapy - No More Disability with Physical Therapy & Rehabilitation” from 11th-12th Dec. 2020. Had published many international publications, and the last was “Ahmed M. Elshinnawy, Karim A. Fathy, Amir N. Wadee, and Islam H. Fayed. Influence of Cardiorespiratory Fitness on Walking Performance in Chronic Hemiplegic Patients with Myocardial Infarction. IJPR; 10: (8) 119-127. 2021.”

Dr. Siham Mohamed Fahmy, brigadier Dr and Head of Hyperbaric Oxygen Therapy Unit at Kobri-El Koba Military Medical Hospital, Cairo Egypt. Post passing medical and operating training courses in Hyperbaric Medicine. She had experienced acupuncture therapy from 2009 after her TCM diploma from faculty of Traditional Chinese Medicine 2007-2008, Shanghai Second Military Medical University, China. She is a teacher at Military Medical Academy and Lecturer of Traditional Chinese Medicine, Faculty of Physical Therapy, Egyptian Chinese University. She holds a master degree of physical therapy for surgery, faculty of Physical Therapy, Cairo University, Egypt, and PhD of physical therapy for surgery, Cairo University, Egypt. Her Master thesis is titled “Effect of Laser Therapy on Venous Ulcer Healing” and PhD thesis is titled “Effect of Acupuncture for Primary Open Angle Glaucoma”. Published many international articles and participated in many international conferences at China, London, Cairo. Her research interests are phototherapy, low level laser therapy, hyperbaric oxygen therapy, wound healing, acupuncture therapy, eye disorders, cranial nerve palsies.

Heba A. Bahey El-Deen

Ass. Prof. Dr. Amir N. Wadee is an assistant Professor of Physical Therapy in Department of Physical Therapy for Basic Sciences, Cairo University, Egypt. Ph.D. Cairo University 2009: “Influence of Low Level Laser Therapy on Delayed Onset Muscle Soreness in Normal Subjects”. M.Sc. Cairo University 2003: “Influence of Low Intensity Laser Pulse Frequencies on Blood Flow in Normal Subjects”. Engagement in teaching activities of practical courses of Physical Therapy from 1998-2008. Engagement in teaching activities of theoretical courses of Physical Therapy from 2008 till now. Had attended many international conferences, and the last was “The Second Scientific Conference of Physical Therapy - No More Disability with Physical Therapy & Rehabilitation” from 11th-12th Dec. 2020. Had published many international publications, and the last was “Ahmed M. Elshinnawy, Karim A. Fathy, Amir N. Wadee, and Islam H. Fayed. Influence of Cardiorespiratory Fitness on Walking Performance in Chronic Hemiplegic Patients with Myocardial Infarction. IJPR; 10: (8) 119-127. 2021.”

Dr. Heba Ahmed Bahey El-Deen is an Associate Professor of Physical Therapy and Coordinator of Department of Physical Therapy and Health Rehabilitation. College of Applied Medical Sciences at Jouf University, North Province, Kingdom of Saudi Arabia. She is a Member of Scientific Research and Postgraduate Studies Committee. She is Former Department of Physical Therapy for Surgery, Faculty of Physical Therapy at Misr University for Science and Technology, Egypt. She holds a Master's degree in Physical Therapy from Cairo University, Egypt and a PhD in Physical Therapy for Surgery from Cairo University, Egypt. She attended (24 Months) of Specialized Diploma Degree in “Medical LASER Applications”. Diploma Specialty in physical medicine and physiotherapy - National Institute of Laser Enhanced Sciences (NILES) - Cairo University. She had a Foundation certificate in “Business Administration”. (Very Good)- AUC-American University in Cairo and Career Certificate in “Management”. (Very Good)- AUC-American University in Cairo. Her Master Thesis is titled “Physical Therapy Approach after Plastic Surgery in Crushed Hand”. PhD Thesis is titled “Efficacy of Light Emitting Diode Therapy on Diabetic Foot Ulcer”. Her research interests are Phototherapy in Ulcers – Hyperbaric Oxygen Therapy – Rehabilitation in Hemodialysis- Burn Rehabilitation-Respiratory Therapy.